Signet-ring Adenocarcinoma of the Duodenum Spreading through Brunner's Gland Adenoma
Received Date: Nov 05, 2019 / Accepted Date: Feb 04, 2020 / Published Date: Feb 12, 2020
Abstract
We present a rare case of a 66-year-old male with evidence of a polypoid mass in the first section of the duodenum. He first received the diagnosis of Brunner’s gland adenoma with foci of signet-ring adenocarcinoma on
biopsy and after two months he underwent distal gastrectomy extended to the first section of duodenum. The resected specimen contained one polyp of 2.5 cm (maximum diameter). Morphological assessment and
immunohistochemistry were performed and the previous diagnosis of an infiltrating signet-ring cells adenocarcinoma arising from Brunner’s gland was confirmed. Brunner’s gland adenomas are rare tumors of the duodenum. These lesions have previously been described as benign. Some authors described epithelial dysplasia associated with surface erosions, suggesting a malignant potential. In the literature, just few cases of adenocarcinoma originating from Brunner ’ s gland adenoma are described. As far as we know, there have been no previous reports about pure signet-ring adenocarcinomas arising from Brunner’s glands polyp. First diagnosis on biopsy is difficult and could be even more insidious within surgical specimen. This is due to extensive erosions, massive loss of surface epithelium, inflammation, fibrosis and hyperplastic changes, especially when facing with an adenocarcinoma infiltrating in a single-cells manner. Based on our experience, for patient’s better surgical and oncologic management, we think it is important to look carefully at the polyp surface while at the same time considering all the potential pitfalls.
Keywords: Duodenum, Gastrectomy, Inflammation, Fibrosis
Citation: Masu L, Pinamonti M, Coverlizza S (2020) Signet-ring Adenocarcinoma of the Duodenum Spreading through Brunner ’ s Gland Adenoma. J Gastrointest Dig Syst 10: 610. Doi: 10.4172/2161-069X.1000610
Copyright: © 2020 Masu L, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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